Introducing the Session

Say: Last week, we talked about why it is important to cut back on saturated fat, trans fat, and cholesterol in our diets. Can you list three things you can do to make food lower in fat?

Add these answers if not mentioned by group members.

Trim the fat from meat before cooking.

Take off the skin from chicken before cooking and throw it away.

Bake, boil, broil, or grill food instead of frying it.

Ask:At the end of the last session, you made a pledge to eat less saturated fat, trans fat, and cholesterol. What went well? Did you have any problems?Note: Allow 5 minutes for group members to respond.

Ask: Has anyone completed the family health history?Note: Give a prize to group members who have completed the family health history.

Ask: Do any of you want to share what you learned about your family health history?Note: Allow about 5 minutes for group members to respond.

About This Session

Say:I want to start today's session with the words of John H. Johnson of Johnson Publishing, publisher of Ebony and Jet magazines. He said, "If you can somehow think and dream of success in small steps, every time you make a step, every time you accomplish a small goal, it gives you confidence to go on from there."

Ask:What does this quote mean to you? Note: Allow about 5 minutes for group members to respond.

Say: Today, we will discuss why keeping a healthy weight is important to heart health.

Conducting the Session

Facts About Overweight and Obesity

Overweight and obesity increase the risk of heart disease and stroke. Losing even 10 pounds can make a difference.

Nearly 8 in 10 African American women are overweight or obese.

About one in four African American men is overweight or obese.

About one in four African American children is overweight.

(Optional) Tina's Story About Losing Weight: Role Play

Note: Ask for two volunteers to be the actors in the role play. Give these two group members the "Tina's Story About Losing Weight: Role Play," As the trainer, you can read the one-line introduction. After the activity is completed, ask the following questions.

Ask:

What are some of the small changes Tina made that helped her lose weight?

Have any of you made changes recently to your eating and exercise habits that are different from those mentioned in the role play?

Note: Allow about 5 minutes for group members to respond.

Your Weight and Your Health

Say: Being overweight or obese increases your risk of heart disease and stroke. It also can contribute to the development of high blood cholesterol, high blood pressure, and diabetes, which can also cause heart disease.

Say:Being overweight can increase the risk of developing some types of cancer, and it can make other health problems worse, such as arthritis and sleep disorders.

Say:Losing a small amount of weight can improve many health problems that come from being overweight.

What Is a Healthy Weight? Activity

Note: Before beginning this activity, place the scales where group members can weigh themselves in private. Write the following information on the blackboard or on a large piece of paper taped to the wall.

Say:We are going to do an activity to find out if you have a healthy weight or if you should lose weight.

Show picture card 6.1.

Say:We're going to work together to find out if James and Tina have healthy weights, using the BMI chart. The BMI chart lets you measure the weight of a person in relation to his or her height.

Say: James weighs 180 pounds, and he is 6 feet tall. First, look for James' height on the left side of the chart and circle it. Put your finger on the circled number and move your finger to the right until you find the number that corresponds to his weight. The shade of your square will show you if James' weight is healthy, overweight, or obese. His BMI is 24, so James is at a healthy weight. Note: Allow 2 or 3 minutes for group members to look for the answer on the chart.

Say:Now we will find Tina's BMI (following the same steps). Tina weighs 170 pounds, and she is 5 feet, 5 inches tall. Tina's BMI is 28, which means she is overweight.Note: Allow 2 or 3 minutes for group members to look for the answers on the chart.

Say:Now we are going to find out if you have a healthy weight. If you do not know how much you weigh, use the scale to weigh yourself. If you do not know your height, use the wall measure.

Note: Allow 15 minutes for group members to use the scales and wall measure.

Say:Now we're going to take three simple steps to learn if we need to lose weight, and then we're going to find out what actions we should take.

Say:The first step is to find out our BMI, using the chart on the handout that I gave you. We will follow the same process that we used with James and Tina.

Say:Find your height on the left side of the chart, and circle it. Put your finger on the circled number and move your finger to the right until you find the number that corresponds to your weight. The shade of your square will show you if your weight level is healthy, overweight, or obese. You do not have to share your BMI with the group. Just check off your weight level on the handout.

Say:Please raise your hand if you are having trouble, and I will help you.

Say:The second step is to measure your waist.

Show picture card 6.2.

Ask group members to measure their waists using the measuring tape.

Waist Measure

Note: Have group members measure their waists by placing a tape measure around the waist just above the hipbone. Be sure the tape is snug, but not too tight on the stomach. Ask them to relax, exhale, and then measure their waists.

(Optional)Note:Some people may be sensitive about measuring their waists with a tape measure. To make this activity friendlier, you can use curling ribbon. Cut one ribbon at 35 inches for women and one ribbon at 40 inches for men, and give the ribbon to group members. Tell them how long the ribbon measures. If the ribbon does not go all the way around the waist, their waist measurements are high.

Say:Write down your waist measurement, and check off what level it is: healthy or high. A waist measurement of greater than 35 inches for women and greater than 40 inches for men is high. A high waist measurement increases your risk for heart disease.

Say:In the third step, we will find out if you need to lose weight. Look at your weight and waist measurement.

Say:If both are healthy, then you are at a healthy weight and do not need to lose weight. Good for you! Try not to gain weight.

Note: Copy the box onto a large piece of paper.

Risk Factors

High blood pressure

High LDL cholesterol (bad cholesterol)

Low HDL cholesterol (good cholesterol)

High triglycerides

High blood glucose

Family history of heart disease

Not being physically active

Cigarette smoking

Say:Let's review the risk factors. How many of these factors do you have?

Note: Give group members a moment to think about this question.

Say:If your BMI is in the overweight range, and you have two of the factors we just listed, you should lose weight. It is important not to gain more weight. You should also lose weight if you are overweight and have a high waist measurement.

Say:If your weight is in the obese range, you also need to lose weight. It is important to lose weight slowly—about 1 to 2 pounds a week. Ask your doctor or a registered dietitian for help.

Note: Ask group members to look at the handout to see what actions they should take for their weight levels.

Say: This handout is about how decreasing calorie intake and adding small amounts of daily activity can lead to weight loss over time.

Ask for volunteers to read each scene aloud.

Show picture card 6.3.

Say:Like Tina, you can lose weight in a healthy way if you eat smaller portions, eat a variety of foods lower in fat and calories, and increase your activity level.

Say:Most people who lose weight and keep it off do so by losing the weight slowly. They learn to make lasting changes. They eat fewer calories and stay physically active. You should try to lose 1 to 2 pounds each week until you reach a healthy weight.

Ask people to share their experience with the group. Ask them to tell what kept them motivated to lose weight.

Ask:Why do you think it is difficult for some people to lose weight or keep off the weight they lose?

Note: Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add some of the following answers if they are not mentioned.

Some people have a hard time losing weight because:

They lack support from family members or friends.

They do not know how to cook without fat or how to use a recipe.

They believe that healthy foods are too expensive.

Fruits and vegetables cost more than junk food at the local store.

The neighborhood is too dangerous for people to walk in for physical activity, because it lacks well-lit areas.

Working parents are often short on time and energy.

Changing behavior is difficult and takes time and effort.

They think that being heavy means that a person is healthy.

Family activities center around food.

Friends give the wrong message. For example, "You're better off with some extra weight."

Ask:Have you found ways to beat the barriers to losing weight?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add some of the following answers if they are not mentioned.

Find another person who also wants to lose weight. You can talk with this person to stay motivated.

Walk or plan other activities with another person. This makes it more fun, and the time will pass quickly.

Find activities that the whole family can enjoy. That way, everyone can work together to control their weight.

Look for free or low-cost physical activity facilities at local community centers or parks and recreation programs.

Share cooking chores and recipes with a friend. For example, if family members will not eat lower calorie dishes, make a dish and share it with a friend. Your friend can make a dish and share it with you.

Say:Ask your doctor or a registered dietitian to help you develop a plan if you need to lose weight.

Show picture card 6.4.

Say:Losing weight has become a moneymaking business. You hear about miracle diets that claim to help you lose weight quickly and easily. These products make only one thing lighter—and that's your wallet. Be careful about ads that promote diets and exercise products using personal testimonies.

Say:Diets that promise quick weight loss rarely work. Many of these diets include only a few foods. People get bored with them quickly. These diets do not provide all the nutrients and energy your body needs. They are not healthy.

Serving Size Activity

Say:In Session 8, "Make Heart Healthy Eating an Everyday Family Reunion," we will look at how many servings you should eat.

Before the session

Check the "Serving Sizes" handout for the serving size of each food. Measure one serving of each food, and put each in a separate dish or other container.

Place the dishes with these premeasured foods out of sight.

Place the box of cereal, a large bowl of cooked rice, a bowl of fruit or vegetables, a block of cheddar cheese, and a bowl of beans on a table with five dishes, four serving spoons, and a knife.

Ask for five volunteers to come to the table. Ask each person to do one of the following:

Spoon out a serving of cereal and put it on a dish.

Spoon out a serving of cooked rice and put it on a dish.

Cut a serving of cheese and put it on a dish.

Spoon out a serving of the fruit or vegetable and put it on a dish.

Spoon out a serving of beans and put it on a dish.

Bring out the foods you measured before the session. Compare the volunteers' serving sizes with the true amounts.

Give group members the "Serving Sizes" handout. Ask for volunteers to read aloud the serving sizes for each. Tell them to use this handout at home.

Food Label Activity—Calories

Note: This activity will help group members choose foods that are lower in calories.

Say: We have learned that, to lose weight, a person must eat fewer calories than the body burns for energy. In the last session, you learned how to use the food label to choose foods that are lower in saturated fat, trans fat, and cholesterol. Today, we are going to learn how to use the food label to choose foods that are lower in calories.

Show picture card 6.5.

Say:Here's where you can look to find the number of calories in one serving on the food label. This food label shows the number of calories in a can of regular soda.

Say:Look at the food labels at the bottom of the handout for a can of regular soda and a can of diet soda. Which type of soda has fewer calories?

Note: Allow 1 or 2 minutes for group members to respond.

Say:A can of diet soda has zero calories. There are 140 calories in a can of regular soda.

Say:"Fat-free" does not mean free of calories. You need to watch the calories and fat when comparing food labels.

Here are a few examples:

Calories in reduced-fat food

Reduced-fat chocolate chip cookies, 3 cookies (30 grams)

118 calories

Fat-free potato chips, 1 ounce

107 calories

Calories in regular-fat food

Regular chocolate chip cookies, 3 cookies (30 grams)

142 calories

Regular potato chips, 1 ounce

151 calories

Say:Let's try another group activity. I will tell you about a common problem for families today. Then we will learn how to use food labels to help solve the problem.

Give group members the "Tina's Snack Choices" handout. Read "Tina's Problem". Ask group members which foods Tina should serve.

Tina's Problem

Tina and her family like to have snacks when they watch television. Recently, Tina has noticed that her family members have gained weight. Use the food labels to choose some tasty snacks that are lower in calories. What should Tina serve? Write the number of your choice for each pair on the line. Then write the number of calories saved by this choice.

Note: The choices that are lower in calories are underlined below. The number of calories saved by making the right choice is given below each choice.

Say:This recipe makes a good side dish that you can bring to a family gathering or other event. Try the smothered greens with a chicken or fish dish and baked potatoes. The recipe has only 80 calories and 2 grams of fat per serving and is easy to make.

Review of Today's Key Points

Say: Let's review what we learned today.Why is it important to maintain a healthy weight?

Being overweight may increase your risk of heart disease, high blood pressure, high blood cholesterol, diabetes, and some types of cancer.

What is the healthiest way to lose weight?

Eat smaller portions of a variety of foods lower in fat and calories, and increase your physical activity.

How can the food label help you if you need to lose weight?

The food label tells you the serving size and the number of calories per serving. You can compare calories on different packages to choose foods that are lower in calories.

Weekly Pledge

Say:You have learned a lot today about losing weight the healthy way. Now let's think about how you can apply what you have learned. Please think of one change you can make in your everyday life to reach or maintain a healthy weight. This will be your pledge for the week.

Say:Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

I will buy vegetable oil spray when I go to the grocery store next week. I will use the vegetable oil spray instead of butter when I make scrambled eggs for breakfast.

I will walk for 30 minutes for 3 days each week during my lunch break at work, starting tomorrow.

I will eat only half of my entree the next time I eat out to cut down on my food portion. I will take the other half home and save it for another meal.

Say:Write your pledges on the "Ms. Diane's Healthy Lifestyle" handout. Keep this handout in a special place so you can review your pledges and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge.

Say:Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional)Say:

Keeping a personal value in mind can help you make changes in your life to reach and keep a healthy weight. Remember that a personal value is a quality that you consider important.

Today, the value is honesty. Honesty can help you think about what makes you overeat, such as feelings of boredom, stress, or anger, or a lack of time or willpower. Honesty can also free you to talk about your struggles and successes with the friends or loved ones who can support you. Finally, honesty can guide you to choose goals that are realistic for you as you work to change your eating and activity habits for the better.

Say: Today's quote states, "If you can somehow think and dream of success in small steps, every time you make a step, every time you accomplish a small goal, it gives you confidence to go on from there."

Ask:How can you use honesty, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

Say: We will discuss the results of your pledges next week. Don't forget to continue working on your pledges to be more physically active and to cut back on salt, sodium, saturated fat, trans fat, and cholesterol.

Closing

Say: Thank you for coming today. What did you think of today's session?

Note: Allow a moment for group members to respond.

Say: I am looking forward to seeing you at the next session. The next session will be about diabetes and how it relates to heart disease. Please continue to fill out your family health histories.

Note: Think about today's session. What worked and didn't work? Have you made any changes in your own life that were covered in today's session?

Handouts

Tina's Story About Losing Weight: Role Play

Two friends meet at their church picnic and stop to talk.

Jill: Have you lost weight? You look good!

Tina: Yes, I have. I knew that I had gained some weight over the years, but I never thought I was overweight. I realized after my last checkup that those extra pounds really add up! My doctor told me that being overweight raises your risk for heart disease, stroke, and diabetes.

Jill: I've tried a lot of different diets, but I always gain all the weight back and more.

Tina: I didn't diet. I just made some small changes in my eating habits. I also started being physically active for at least 30 minutes every day.

Jill: I just don't have the energy right now to try and lose weight. Besides, everyone in my family is overweight. That's just the way we're built.

Tina: At first, I wasn't sure if I could do it either. I didn't know what to do when I found out that I had to lose 21 pounds to reach a healthy weight. I talked to my husband, James, about my worries. He told me that I could do it and that he would change some of his habits, too. My doctor also gave me some tips.

Jill: So what changes did you make? Could I make them, too?

Tina: Sure you can! I started by watching how much food I put on my plate. Also, I stopped going back for second helpings. I used to eat until I was too full.

Jill: Don't you feel hungry?

Tina: I give my body about 15 minutes to get the message that I'm full. If I still feel a little hungry, I eat a piece of fruit or drink water. Juice and soda are very sugary and can really add to your weight.

Jill: Sometimes I eat when I'm not hungry, like when I feel bored, stressed, or worried.

Tina: I can relate. Whenever James worked late, I used to eat big bags of cookies and chips while watching TV. Now I try to do something other than eating, like calling a friend.

Jill: How much weight have you lost so far?

Tina: I've lost 10 pounds, and I'm still working to lose the rest. I have my hard days when I feel like giving up. But then I remember how much more energy I have these days and how good I feel overall.

Jill: I know I should lose some weight, too. Heart disease runs in my family, and I need to stick around for my girls. Do you think you can help me?

Tina: Sure. How about joining me on a walk this weekend?

Jill: Just tell me when and where.

Body Mass Index (BMI) Chart

Do You Need To Lose Weight?

Let's follow these steps to find out if you need to lose weight.

Learn if your weight is healthy.

Weigh yourself. Use the BMI chart to find out whether your weight is in the healthy range for people of your height. Find your height on the left of the chart, and circle it. Put your finger on the circled number, and move your finger to the right until you find the line that corresponds to your weight. The shade of your square will show you if your weight level is healthy, overweight, or obese.

Check off your weight level below to find out if you need to lose weight.

Level

Action

Healthy Weight

Good for you! Try not to gain any weight.

Overweight

It is important not to gain more weight.

You need to lose weight if you are overweight and:

Have two or more heart disease risk factors or

Have a high waist measurement.

Ask your doctor or a registered dietitian for help.

Obese

You need to lose weight. Lose weight slowly—about 1 to 2 pounds a week. Ask your doctor or a registered dietitian for help.

Ms. Diane's Healthy Lifestyle

Losing weight means making long-term changes.

Here's how Ms. Diane found success.

I have had diabetes for 25 years. I used to weigh 200 pounds. I was able to lose weight by eating smaller portions of the foods I like. I also eat fewer fatty foods and sweets and more fruits and vegetables. After I lost my first 25 pounds, my back and foot problems went away. Now I stay at a healthy weight and control my diabetes while still enjoying what I eat.

Try these tips to get started.

Eat fewer foods that are high in saturated fat—such as fried chicken, pork rinds, and sausage.

Cut down on cakes, pastries, candy, and soft drinks.

Eat more fruits, vegetables, and whole grains.

Make stews with lean meat and vegetables.

Serve small portions, and eat salad if you are still hungry. Don't skip meals.

Aim for 60 minutes of physical activity each day.

Make your personal pledge to do what the Harris family is doing! Look at these examples:

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.† Serving sizes vary between 1/2 cup and 1 1/3 cups, depending on cereal type. Check the product's Nutrition Facts label.‡ Lactose-free alternatives for people who are lactose intolerant.§ Limit the number of egg yolks to four per week.

Read the Food Label for Calories!

Food labels tell you what you need to know about choosing foods that are lower in calories. Here's a food label for a can of regular soda.

Amount Per Serving The nutrient amounts are for one serving. So, if you eat more than a serving, you need to add nutrient amounts. For example, if you drink two cans of soda in a day, you need to double the amount of calories on the label.

Diet Soda A can of diet soda has 0 calories and no sugar. Drinking diet soda or water instead of regular soda saves a lot of calories, which is important when trying to lose weight or maintain a healthy weight.